Opioids contribute to nearly 2,000 overdose deaths in North Carolina each year, making it the leading cause of injury death in the state. The COVID-19 pandemic has made matters worse, creating isolation for opioid users and cutting off access to treatment and support. But counterintuitively, the pandemic may also be creating an environment to experiment with new forms of remote treatment.
During a Think Global webinar on March 17, Duke researchers on opioid use, treatment and mental health discussed a pilot project to provide mental health support for people who use opioids using telemedicine. Called TeMPO (Telemedicine and Mental health support for People who use Opioids), the project was launched by the Duke School of Nursing to address barriers to care for people in rural counties in North Carolina, as well as to test mental health supports that can encourage recovery from opioid use.
Watch the full discussion below, or scroll down for a summary of comments.
ABOUT THE SPEAKERS
Theresa Coles is an assistant professor of population health sciences at Duke
Brandon Knettel is a licensed psychologist and assistant research professor in the Duke School of Nursing with a secondary appointment in the Duke Global Health Institute. At DGHI, he teaches a course in global mental health for the Master of Science in Global Health program.
Nidhi Sachdeva is a senior research program leader at the Duke School of Medicine.
Padma Gulur is a professor of anesthesiology and population health sciences at Duke and director of pain management strategy and opioid surveillance for the Duke University Health System.
Hilary Campbell is a research associate at the Duke-Margolis Center for Health Policy and recently served as the acting special assistant for the chief data officer of the North Carolina Department of Health and Human Services.
HIGHLIGHTS
About the extent of the opioid crisis in North Carolina
Nidhi Sachdeva:
“In North Carolina in 2019, an average of six people died every single day from unintentional medication or drug overdose. Although we’ve done a lot of great things – focus on systems, focus on policy, focus on community efforts – unfortunately we’re dealing with a crashing of multiple epidemics at the same time.”
On how the majority of opioid deaths come from illicit opioids, rather than prescriptions:
“We have a whole generation of people who are physically dependent on opioids, and the systems of care haven’t necessarily caught up with the way the epidemic is changing so quickly.”
The role of health systems in managing supply of opioids
Padma Gulur:
“Opioids have and will continue to play a role in pain management. One area where they are particularly useful is in dealing with post-operative pain, which can be quite intense. … But opioids really should be reserved for severe pain.”
“We in the United States use 80 to 90 percent of the world’s opioids, and we fortunately do not have that disproportionate a level of pain compared to other places in the world. And so obviously there are other strategies that can be used to manage pain, and we should be focusing on that.”
Why reducing opioid prescriptions haven’t reduced opioid use
Padma Gulur:
“If we keep our focus just on reducing the amount of opioids that are prescribed, it can have unintended consequences. Merely reducing opioid prescriptions, there is a growing concern nationally that it has led to an increase in illicit and psychoactive drug overdoses and the need for patients to turn to other substances.”
Hilary Campbell, on data trends in opioid use:
“The trend that we were seeing was that the supply side was going down, so opioid prescriptions were going down. But we were seeing at the same time the crisis getting worse. It looks like you don’t want to put your efforts on just reducing the amount of prescription opioids without focusing equally or more so on the treatment side.”
Challenges for opioid treatment in rural communities
Theresa Coles:
We know that rural counties certainly have unique challenges for offering evidence-based treatments for opioid use disorder. Two of those are transportation for patients and consistent funding.”
On studies into opioid treatment rograms in Granville and Vance counties:
“What we found is that the barriers to success in Granville and Vance were really inconsistent funding where there’s a lapse in service and access. One of the areas that was really impacted was behavioral health, so having a counselor and having social workers there consistently.”
How academic research can partner with community programs
Nidhi Sachdeva:
“We have a lot of innovation happening on the ground, and so there is a unique opportunity through community partnership to take lessons learned in one part of the state and apply them to another.”
“I think a lot of folks have skepticism about working with academic institutions. They risk a lot by working with us. So it is really key to involve folks at every stage of the process so that they feel they still have ownership, from the initial design of an idea through dissemination.”
Uses of telehealth in opioid counseling and recovery
Padma Gulur:
“The COVID pandemic, while it has definitely upturned everything that we know and do in some way or other, ahs also allowed for some progress that I think is going to be extremely helpful. (An example is) the use of telehealth to expand access, especially in rural communities, and to be able to give the same level of expertise in those areas.”
Theresa Coles, on how rural counties adapted to using telehealth during the pandemic:
“Telehealth, though it was a challenge in terms of technical issues, really bridged the gap for some of the transportation issues for patients.”
“With telehealth, I suspect that it would be useful to bring in mental health providers that may not actually be living in the area. That’s another one of the challenges; in a rural area, there are fewer mental health providers, and if telehealth can open up opportunities for patients to connect with other individuals and still obtain mental health services and behavioral health services, that would be a useful next step.”
Mental health support for opioid users
Brandon Knettel:
“There’s been some really interesting, kind of conflicting, data on the extent to which mental health support in collaboration with opioid use disorder helps. What seems to help is when you focus on the underlying social challenges in addition to the substance use.”
Theresa Coles:
“As people are working through (treatment), we see a lot of impacts where folks are being more integrated into their community and more integrated with others in their families. They are working through relationships that had kind of dropped off with their opioid use, and they are transitioning back in. And I think the mental health component of that is extremely important.”
